The larynx, or voice box, is part of the throat. It is an organ with several roles. It protects the airway to help us swallow, regulates airflow into our lungs, and creates sound for speech. Its vocal cords vibrate with the flow of air to make the sounds that form our voice.
The larynx includes three parts. The upper part, with the epiglottis (which keeps food out of the lungs and helps us swallow), is called the Supraglottis. The middle part, where the vocal cords are found, is called the Glottis. The lower part, just above the trachea (windpipe), is called the Subglottis. Cancer may begin in any part of the larynx, and it can spread to nearby tissue or other parts of the body.
Laryngeal cancer is a head and neck cancer that begins when abnormal (malignant) cells form in the larynx. Most laryngeal cancers begin in squamous cells, which line the inside of the larynx. Cancer rarely develops from the cells of the minor salivary glands in the larynx, but when it does, it is called adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.
Laryngeal cancer is a rare cancer. It can grow in the larynx, mainly due to smoking tobacco or drinking alcohol. It can spread to nearby lymph nodes in the neck, to the back of the tongue or to other parts of the throat, neck and even lungs.
When squamous cells grow abnormally, they don’t always form cancer. By removing the cause (such as smoking), early abnormal growths could “heal”, and the problem could be reversed. In early stages of laryngeal cancer (such as carcinoma in situ (CIS)), it is more easily treated and cured. In later stages, laryngeal cancer is much harder to treat.
Risk Factors, Diagnosis & Staging
The primary risk factors for laryngeal cancer include:
- Use of tobacco products
- Drinking too much alcohol
Other risks include:
- Poor nutrition and vitamin deficiencies
- Workplace exposure to wood dust, paint fumes, and certain chemicals used in the metalworking, petroleum, plastics, and textile industries
- Being male, and over the age of 65P
The most common symptoms of laryngeal cancer are:
- Sore throat or cough that does not go away
- Trouble or pain when swallowing
- Ear pain
- A lump in the neck or throat
- A change or hoarseness in the voice that doesn’t go away
Diagnosing Head and Neck Cancer
Your doctor will do a physical exam and ask you many questions. It is important to describe how you have been feeling and any changes you have noticed, such as pain, difficulty swallowing, mouth or throat sores, or changes in your voice.
Your doctor may order some of these tests:
Endoscopy - A thin, lighted tube is inserted through the nose to look at the back of your nose and throat. This may be done at the doctor’s office, often after using numbing spray.
Biopsy - A sample of tissue is removed to check for cancer.
Fine needle aspiration - This is a type of biopsy done with a small needle to see if you have cancer. It is often used to assess lumps in the neck.
Fiberoptic endoscopic evaluation of swallowing test (FEES) - A thin, lighted tube is inserted through your nose and down your throat so that the health care provider can watch how you swallow from inside.
Biomarker testing/Molecular testing of the tumor - Your doctor may want to test your tumor for P16 or HPV. In certain kinds of head and neck cancer (oropharyngeal squamous cell carcinomas), knowing this test result will help your doctor decide on the treatment that is best for you. The tumor may also be assessed for the Epstein-Barr Virus (EBV). This can cause cancers in the nasopharynx (upper part of the throat behind the nose).
Your doctor may also use the following diagnostic tests:
- CT Scan
- PET or PET-CT Scan
- Modified barium swallow studies (a series of x-rays taken after you swallow a barium drink)
If you are diagnosed with laryngeal cancer, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.
Laryngeal cancer is staged with the AJCC (American Joint Committee on Cancer) system. This is a rating system that assigns a measurement for TNM:
- T = Tumor characteristics, based on imaging tests. This describes how big the tumor is and how far into the larynx cancer has grown.
- N = Lymph Nodes involved. This defines if and how cancer has spread to lymph nodes in the neck.
- M = Metastases. This explains if and where cancer has spread beyond the neck (into organs in the chest, liver or bones).
Each of these factors are defined with a number ranging from 0 (or x – meaning its very early disease) to 4 a, b, c (meaning the disease is very advanced). After this, the cancer’s Stage is defined with a scale from “Stage 0” (for very early signs of cancer), to Stage IV a, b or c (for very advanced cancers).
Stage 0 - Abnormal cells are found in the lining of the larynx. It has not spread beyond this are to lymph nodes or other parts of the body. (T0, N0, M0)
Stage I - cancer has formed in a specific area of the larynx (T1, N0, M0):
- In the Supraglottis , but the vocal cords are not affected
- In the Glottis but the vocal cords still move normally
- In the Subglottis
Stage II - cancer is in the larynx but may have spread beyond the area where the cancer began (T2, N0, M0):
- It is in more than one area of the supraglottis or surrounding tissues.
- It has spread from the glottis to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.
- It has spread from the subglottis to one or both vocal cords. They may not work the way they should.
Stage III - depends on whether cancer has spread from the supraglottis, glottis or subglottis. (T1-T3, N0 or N1, M0)
- Stage III in the Supraglottis: Either cancer is in the larynx only and the vocal cords cannot move. Or cancer is in tissues next to the larynx, but the vocal cords can work. Or, cancer has spread to the base of the tongue. Cancer may have spread to one lymph node on the same side of the neck as the original tumor. The lymph node is three centimeters or smaller. Cancer hasn’t spread beyond this area.
- Stage III in the Glottis: Either cancer is found in the larynx only, but the vocal cords don’t work. Or, it has spread to the inner thyroid cartilage. Or cancer is in one or both vocal cords but the vocal cords work normally. Or, it has spread to the supraglottis, subglottis or both but the vocal cords work normally. One lymph node near the original tumor is also found to have cancer. The lymph node is three centimeters or smaller. Cancer hasn’t spread to other parts of the body...
- In Stage III cancer in the Subglottis: Either cancer is in the larynx and the vocal cords cannot move. Or cancer has spread through the inner thyroid cartilage. Or cancer is in the subglottis. Or Cancer has spread to one or both vocal cords but they still work normally. Cancer has also spread to one lymph node near the original tumor and the lymph node is three centimeters or smaller. Cancer has not spread to other parts of the body.
Stage IV - divided into stage IVA, IVB, and IVC. Each substage is the same for cancer in the supraglottis, glottis or subglottis. (T1-T4a, N0-N2, M0-M1)
- In Stage IVA – Either cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus. And cancer has spread to one lymph node near the original tumor and the lymph node is 3 centimeters or smaller. Or, cancer has spread from the supraglottis, glottis, or subglottis to tissues beyond the larynx. The vocal cords may not work. And, cancer has spread to lymph nodes and beyond the outside covering of the lymph node. Or, the lymph node is as large as six centimeters. Or, lymph nodes on both sides of the neck are affected. Cancer hasn’t spread beyond this area.
- In Stage IVB - Cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size. Or, cancer has spread to a lymph node that is larger than six centimeters and may have spread all the way to the front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cords may not move normally.
- Stage IVC - Cancer has spread to other parts of the body such as the lungs, liver or bone.
Treatment & Side Effects Management
Surgery is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:
- Cordectomy - Surgery to remove the vocal cords only.
- Supraglottic laryngectomy - Surgery to remove the supraglottis only.
- Hemilaryngectomy - Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
- Partial laryngectomy - Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.
- Total laryngectomy - Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheotomy.
- Thyroidectomy - The removal of all or part of the thyroid gland.
- Laser surgery - A surgical procedure that uses a laser beam as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, called adjuvant therapy, lowers the risk that the cancer will come back.
If you have a laryngectomy, you will need to learn a new way to speak because your voice box will be removed. Your nose and mouth will be permanently separated from your windpipe and lungs, and you will be breathing through a new opening in your neck called a stoma. Having a laryngectomy changes lung function, including increased mucus and coughing. After a laryngectomy or other surgery in your neck, parts of your neck and throat may feel numb because your nerves have been cut. If lymph nodes in your neck were removed, your shoulder and neck may become weak and stiff. Talking with your doctor about what to expect during your recovery can help you cope with side effects.